Carolyn s perchuk rn mn winnipeg regional health authority university of manitoba
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Carolyn S. Perchuk RN, MN Winnipeg Regional Health Authority University of Manitoba. Families First & School Readiness. Family First Program Home visiting program in Public Heath 1999 Health Child Manitoba Research based

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Families First & School Readiness

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Carolyn S. Perchuk RN, MN

Winnipeg Regional Health Authority

University of Manitoba

Families First &School Readiness

  • Family First Program

    • Home visiting program in Public Heath

    • 1999

    • Health Child Manitoba

    • Research based

    • The purpose of the program is to decrease child maltreatment


Reference:Great Kids Inc.(2004)

  • Parenting

    • Increased positive parenting (ES 0.81)

    • Decreased hostile parenting (ES - 0.53)

Evaluation of Families First Program ...

Reference: Healthy Child Manitoba (2010)

NOT Evaluated: Families First effect on School Readiness.

Research Question

Is there a relationship between families participating in the Families First home visiting program and an increase in their child’s school readiness on entering kindergarten as assessed by the EDI?

Education is a social determinant of health

Evidence: academic ability in K predictive of long term

school readiness

grade 3 success

complete grade 9

graduate grade 12

Identify family

Risk factors

Intervene to build skill and

improve environment

Improve parent child attachment

Improve Outcomes

The Manitoba

Families First Program

  • Nurses and para professionals

  • Working together

  • Prenatal and postpartum

  • Universal screen

  • In-depth parent survey or fsc

  • Family centered

  • Curriculum

  • Voluntary

  • 3 years


  • Quantitative research design

  • Secondary data analysis of data from Healthy Child Manitoba Office (HCMO) data base

Measurement Tools

Screening Tools'

Sensitivity and Specificity



Children not in Care

Children in Care

83% scored

« not atrisk »

On Families First


77% scored

« at risk »

on Screen

  • Parent's childhood experience

  • Lifestyle behaviours and mental health

  • Parenting experience

  • Coping skills and support systems

  • Current stresses

  • Anger management skills

  • Expectations of infant's development,

    milestones, and behaviours

  • Plans for discipline

  • Perception of new infant

  • Bonding and attachment

Family Stress Checklist

Reference:Great Kids Inc.(2004)


Program Group

Control Group

Positive screen +3

Positive FSC +25

Was enrolled in the FF program

Positive screen +3

Positive FSC +25

Receive NO program

No program

Due to not

Enough resources

No program

Due to

Refused Services

The Early Development Instrument

Five Domains

Physical health and wellbeing

Social Competence

Emotional Maturity

Language and Cognitive Development

Communication Skills and General Knowledge

Score in each domain 0-10

Data accessed through data sharing agreement with the MB government

SPSS software used for data analysis (alpha .05)

Imputation For Missing Data

Used Sequential regression multiple imputation (SRMI)where other variables are used as predictors for missing values

Multiple imputations (10 cycles) as accounts for statistical uncertainty in the imputations- cycles improve outcome variables

T test to Assess for Homogeneity of 2 Groups

- Child’s age at time of EDI

  • FSC score

  • Age of mother at the birth of the child

  • Last two statistical difference but not clinical

Chi square to assess for Homogeneity of the 2 Groups

  • screened prenatally

  • low education level of mother

  • on social assistance/financial difficulty

  • mother’s history of depression

  • history of abuse as a child for mother or father of baby

  • no prenatal care before 6 months

  • family screened prenatally

  • lone parent family

  • teen parent

  • alcohol or drug use of mom during pregnancy

  • current substance use by mother

  • social isolation

  • violence between parents.

Results of Chi Square

Important to consider not significantly different:

Teen mother

Lone parent

Low education mom

Social isolation

On social assistance/financial difficulties

Depression of mom

Violence between parents

Results of Chi Square

Significant differences:

-no prenatal care (16%:11%)

-alcohol use by mother in pregnancy-higher control (48%:36%)

-drug use by mom during pregnancy-higher control (25%:17%)

-mother has history of child abuse- more in control (41%:29%)

-father has history of child abuse- more in program (12%:27%)

Multiple Linear Regression – Effect Independent Variables

Y= a + (b1)(x1) + (b2)(x2) + (b3)(x3)+ (b4)(x4)

Independent Variables: child’s gender; age of child at EDI; screened prenatally; maternal age; alcohol use by mother in pregnancy; drug use by mother during pregnancy; teen parent; low education mother; lone parent; on social assistance/financial difficulty; no prenatal care before 6 mos; mother hx depression; current substance use by mother; social isolation; violence between parents; mother has hx of being abused as child; father has hx of being abused as a child; fsc score;in families first program.

FF Program No FF Program

One model for each EDI domain

Results of Data Analysis:Multiple Regression AnalysisGender and child’s month of birth at EDI significant for all


Physical Health and Wellbeing

-In Families First p=.057

-low education mother p=.005

-alcohol use by mother p=.043


Physical Health and Wellbeing

In Families First (FF) marginal significance

Answer research question that there is only a threshold relationship between FF and one domain of the EDI school readiness tool

Domain:Social Competence

Low education of mother p=.002

Social Isolation/lack supports p=.030

Mother’s history of child abuse p=.009

Domain: Emotional Maturity

Low education of mother p= .003

Social isolation/ Lack of supports p= .013

Mother’s history of child abuse p= .041

Domain:Language and Cognitive Development

Low education of mother p= .002

On social assistance/financial difficulties p= .004

Violence between parents p= .052

Domain: Communication and General Knowledge

Low education of mom p= .003

Social isolation/lack of supports p= .002

Violence between parents p= .007


Home Visiting

Research identifies difficulty to achieving consistency may be affecting outcomes ie. varying dosage- early in program

If enrol in program but don’t ever engage or engage sporadically could affect outcomes

Decreased number enter prenatally and research has shown greater success with prenatal


Policy and Program

Explore strengthening FF’s influence on areas that promote school readiness

Consider increased resources to help parents complete high school- ? More childcare or baby labs in high schools

Query if could strengthen FF’s influence on mother’s returning to or staying in high school

Transportation for mother/child to school program

Tutoring programs for mothers who are struggling to upgrade their skills

  • The presenter would like to acknowledge the Healthy Child Manitoba Office including Teresa Meyer, Senior Research Analyst, and the Manitoba Government’s contribution, in providing access to the Research Project Data Set. The results and conclusions are those of the authors and no official endorsement by Manitoba Government is intended or should be inferred.

  • The presenter would like to acknowledge the supportive direction and guidance of committee members Dr. Benita Cohen and Dr. Christine Ateah, University of Manitoba Faculty of Nursing. Dr. Mariette Chartier, Manitoba Centre for Health Policy, University of Manitoba.


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